Neuro Flashcards
Unilateral, severe periorbital HA with tearing and conjuctival erythema
Cluster HA
Prophylactic Tx migraine
AntiHTN
Antidepressants
Anticonvulsants
Diet changes
Most common pituitary tumor. Tx?
Prolactinoma DA agonist (bromocriptine)
55 yo pt presents with acute βbroken speechβ. What type of aphasia? What lobe and vascular distribution?
Brocaβs aphasia
Frontal Lobe, left MCA distribution
Most common cause SAH
Trauma
2nd: berry aneurysm
Crescent shaped hyperdensity on CT that does NOT cross midline
What vessels affected
Subdural hematoma
Bridging veins
Hx significant for initial altered mental status with an intervening lucid interval. Dx? Source? Tx
Epidural hematoma
Middle meningeal a.
Neurosurgical evacuation
CSF findings with SAH
Elevated ICP, RBC, xanthochromia
Albuminocytologic dissociation
GBS (inc protein in CSF without significant inc in cell count)
Cold water flushed into ptβs ear, fast phase of nystagmus toward opposite side, Normal or Pathological?
Normal
Most common primary sources of mets to brain
Lung
Breast
Skin (melanoma)
GI tract
May be seen in kids who are accused of inattention in class and confused with ADHD
Absence seizures
Most frequent presentation of intracranial neoplasm
HA
Primary neoplasm much less common than brain mets
Most common cause of seizures in children (2-10 yr)
Infection
Febrile seizures
Trauma
Idiopathic
Most common cause seizures young adults (18-35)
Trauma
Alcohol
Brain tumor
First line med for status epilepticus
IV BDZ
Confusion, confabulation, opthalmoplegia, ataxia
Wernickeβs due to def thiamine
% lesion for CAE
70% if Sx
Most common causes dementia
AD
multi-infarct
Combined UMN and LMN disorder
ALS
Rigidity and stiffness with unilateral resting tremor and masked facies
PD
Mainstay Tx PD
Leveodopa/carbidopa
Tx GBS
IVIG or plasmapheresis
Avoid steroids
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior
HD
6 yo girl presents with port wine stain in V2 distribution with mental retardation, seizures, and ipsilateral leptomeningeal angioma
Sturge WEber
Tx: Sx
Possible focal cerebral resection of affected lobe
Multiple cafe au lait spots on skin
NF1
Hyperphagia, hypersexuality, hyperorality, hyperdocility
Kluver Bucy (amygdala)
May be administered to Sx pt to Dx MG
Edrophononium
ACA supplies
Medial and superior surfaces
Frontal lobes
MCA supplies
Lateral surfaces and temporal lobes
PCA supplies
Inferior surfaces and occipital lobes
Basilar artery supplies
Midbrain and brainstem-pons
AICA supplies
Brainstem (pons)
Part of cerebellum
PICA
Brainstem (medulla)
Parts of cerebellum
Dorsal columns medial lemniscus of spinal cord responsible for β¦
Anatomical structures involved with this pathwayβ¦
Pressure, vibration, 2 point discrimination, proprioception
Paciniβs
Meissnerβs
Mm spindles
Golgi tendon organs
Fasciculus gracilis
Lower body, extremities
Fasciculus cuneatus
Upper body, extremities
Lateral corticospinal tract responsible for, what parts of body
Voluntary Motor - contralateral
Arms more medial
Legs more lateral
Spinothalamic tract responsible for..
Anatomical structuresβ¦
pain and temperature
Sacral posterior
Cervical anterior
Free n endings, pain fibers
Tracts affected by ALS
Sx
Corticospinal trac - voluntary movement
anterior horn - motor
Sx: spastic and flaccid paralysis
Tracts affected by Poliomyelitis
Sx
anterior horn
Sx: flaccid paralysis
Tracts affect by tabes dorsalis
Part of what disease process
Sx
Dorsal columns
Tertiary syphilis
Impaired proprioception and pain
Tracts affected by Vit B12 def
Sx
Dorsal columns, corticospinal tract
Bilat loss vibration and discrimination; Bilateral spastic paresis affecting legs before arms
Tracts affected by spinal artery syndrome
Sx
Corticospinal, spinothalamic, central horn, lateral gray matter = DORSAL COLUMN SPARED
Sx: bilat loss pain and temp (one level below lesion), bilat spastic paresis (below lesion), bilat flaccid paralysis (level of lesion)
Syringomelia - tracts affected
Sx
anterior horn, anterior white commissure
Sx: Bilat loss of pain and temp (one level below lesion), bilat flaccid paralysis (level of lesion)
Brown Sequard Syndrome- tracts
Sx
All tracts on ONE SIDE of spinal cord
Sx: ALL ARE BELOW LESION- Ipsi loss of vibration and discrimination, ipsi spastic paralysis, contra loss of pain and temp
CN I
Type
Fcn
OLFACTORY
Sensory
Smell
CN II
Type
Fcn
OPTIC
Sensory
Sight
CN III
Type
Fcn
OCULOMOTOR
Motor
Medial, sup, inf rectus mm
Inf oblique mm, ciliary mm, sphincter of eye
CN IV
Type
Fcn
TROCHLEAR
Motor
Superior oblique of eye
CN V
Type
Fcn
TRIGEMINAL
Both
Sensation face, mm of mastication
CN VI
Type
Fcn
ADBUCENS
Motor
Lateral rectus of eye
CN VII
Type
Fcn
FACIAL
Both
Taste (ant 2/3 tongue), mm facial expression, sapedius mm, stylohyoid mm, digastric mm, lacrimal, submandibular, sublingual
CN VIII
Type
Fcn
VESTIBULOCOCHLEAR
Sensory
Hearing, balance
CN IX
Type
Fcn
GLOSSOPHARYNGEAL
Both
Taste (post 1/3 tongue), pharyngeal sensation, stylopharyngeus mm, parotid gland
CN X
Type
Fcn
VAGUS
Both
Sensation of trachea, esophagus, viscera; laryngeal, pharyngeal mm; visceral autonomics
CN XI
Type
Fcn
ACCESSORY
Motor
SCM and trapezius
CN XII
HYPOGLOSSAL
Motor
Tongue
Newborn most common cause meningitis
GBS
1 month - 2 yr most common cause meningitis
Strep pneumo
N meningitidis
2-18 yr most common cause meningitis
N meningitidis
18-60 yr most common cause meningitis
S pneumo
80+ most common cause meningitis
S pneumo
Reason to not do lumbar puncture
Signs of increased ICP -Papilledema -Focal neuro deficits -Pupil assymetry Risk of uncal herniation
Children with viral infection given aspirin
Reyeβs syndrome
Encephalitis
Brudzinski sign
Neck flexion in supine pt causes reflexive hip flexion
Kernig sign
Painful knee extension with hip flexion in supinre pt
Meningitis + N. meningitidis causes what Sx
Petechiae
Tx bacterial meningitis
3rd gen cephalosporin until cultures return
Close contacts: Rifampin and cipro if Neisseria
Tx fungal meningitis
Amphotericin B
Tx TB meningitis
RIPE
Rifampin, isoniazid, pyrazinamde, ethambutol
Labs meningitis: Inc WBC w/ PMN, INc P, Dec Glc, Dec Prot
Bacterial
Labs meningitis: Inc WBC w/ lymph, INc P, dec glc, inc prot
Fungal or TB
Labs meningitis: inc WBC w/ lymph, INc P, glc and prot normal
Viral
Encephalitis infection - skin lesions
HSV
Encephalitis infection - parotid swelling
Mumps
Encephalitis infection- macupapular rash
WNV
Ring enhancing lesion
Brain abscess
Negri bodies
Rabies
Round eosinophilic inclusions in neurons
Branches affected in trigeminal neuralgia
Maxillary(V2) and mandibular (V3)
Tx trigeminal neuralgia
Carbamazepine
Baclogen, phenytoin, gabapentin, valproate, clonazepam, other antivonculsants
Unilateral throbbing HA w/ N/V
Migraine
Tx migraines
NSAID, ergots, sumatriptans, metoclopramide
Prophy: TCA, Beta blocker, CCB, ergots, anticonvulsants
HA in young man, unilateral, periorbital, lacrimation, Horner
Cluster
Tx cluster
100% O2, ergots, sumatriptan
Prophy like migraines
Horner syndrome
Ptosis
Miosis
Anhidrosis
Bilateral HA with tightness in occipital region or neck
Tension
Tx tension
NSAID, ergots, sumatriptan, relaxation exercises
TIA w/ carotid bruits
Suggest atherosclerosis origin
TIA w/ harsh systolic murmur
Suggest AS cause
Why not Tx HTN immediately after stroke
When to Tx
Dec cerebral perfusion
YES: BP >220/120 or CAD
Associated with berry aneurysm
polycystic kidney disease
Marfan
Traumatic lumbar puncture vs SAH
Traumatic- decline RBC in CSF
Lucid interval
Epidural
Slowly progressive HA wks to days -brain hematoma
Subdural
Convex, lens shaped hyperdensity
Epidural
Concave, crescent hyperdensity
Subdural
Hematoma crosses midline
Epidural
Emergent surgery drainage essential
Epidural
Rupture middle meningeal a/
Epidural
Rupture bridging vv
Subdural
Aphasia: nonfluent with good comprehension, writing aphasia, aware of inabilities
Broca (Expressive)
Located Broca
Inferior frontal gyrus, dorsolateral frontal cortex, anterior parietal
Poor comprehension, word salad, neologisms, not aware of disorder
Wernicke
Posterior superior temporal gyrus, inf parietal lobe
Wernicke
Fluent speech, frequent attempt to corrext word, word substitations
Conduction
Supramarginal gyrus and angular gyrus
Conduction
Nonfluent speech and poor comprehenesion
Global
Large infarct left cerebral hemisphere
Globral
3 W normal P hydrocephalus
Wacky- cognitive impaired
Wet- incontinence
Wobbly- gait changes
Epilepsy vs seizures
Epilepsy: recurrent seizures
Generalized vs partial seizures
Generalized: entire cortex
Partial: focal neuro deficits
Focal sensory or motor WITHOUT loss of consciousness
Simple partial
Sensory- paresthesias, hallucinations
Motor- repetitive or purposeless movement
Hallucinations, automatisms, deja vu, impaired consciousness, postictal
Complex Partial
Sustained contraction of mm (name), repetitive contract and relax (name) brief contraction then repetitive contraction (name), brief repetitive contractions (name), loss of tone (name)
LOSS OF CONSCIOUSNESS, postictal, unilat weakness lasting hrs (name)β
Tonic Clonic Tonic clonic myoclonic atonic Todd paraylsis
Generalized
Brief episodes (5-10 s) of impaired consciousness with normal mm tone, possible eye blinking, no postictal, children
Appear to be daydreaming, are amnestic of evet, stare off into space
Absence
Most commonly in temporal lobe (seizure)
complex partial
EMG shows 3 cycle/s spike and wave pattern
Absence/petit mal
Repetitive or unremitting seizures for > 20 minutes without any period of consciousness
Tx
Status epilepticus
Tx: IV BDZ, if refractory phenobarb or pentobarb
Common signs of PD
SMART Shuffling gait Masklike facies Akinesia Rigidity (cogwheeling) Tremor (resting)